401209 Health Variations 2

401209 Health Variations 2

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401209 Health Variations 2

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401209 Health Variations 2

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Course Code: 401209
University: Western Sydney University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question:

Case study
You are a Registered Nurse working in the emergency department caring for Ben Summer who is 19 years of age.
Medical history
Ben visited his local doctor after experiencing increased appetite and excessive thirst. He has been unusually tired when playing football and hasn’t been able to perform at his best. He has lost 10 kilograms of weight over a two week period and has been frequently urinating at night. The doctor suspected type 1 diabetes and tested his urine, which was positive for glucose and ketones. A random capillary blood glucose level was 25.0mmol/L and blood ketone level was 1.5mmol/L. Ben was advised to attend the hospital emergency department immediately.
Social history
Ben lives with his mother (Susan), father (John) and 12 year old brother (Jacob). He attends university full time, studying engineering and works at McDonalds on a casual basis. Ben plays football on the weekends and trains two days during the week. He has a girlfriend Rachel and they both enjoy surfing at the beach.
Emergency department review
Two hours after review by the local doctor, Ben’s capillary blood glucose level (BGL) was 26.0mmol/L and blood ketone level was 1.6mmol/L. Other vital signs were within normal limits. After review by the endocrinologist, Ben was given a provisional diagnosis of type 1 diabetes based on his symptoms and family history of autoimmune disease (His mother has hyperthyroidism, Graves’ disease). His blood test confirmed that he did not have ketoacidosis.
Treatment plan
Ben was prescribed subcutaneous insulin; Aspart (NovoRapid) Flexpen 10 units TDS and Glargine (Lantus) Solostar 30 units nocte. He was referred to the diabetes service for ongoing care.

Part A
1.Explain the 11 components of a valid routine subcutaneous insulin medication order and why this is important. Support your answer with academic or clinical guideline references. 
 
2.Explain why Ben has been prescribed this medication. Relate to pathophysiology of type 1 diabetes and the mechanism of action of NovoRapid insulin. Support your answer with academic references. 
 
3.What is the onset, peak and duration of action for NovoRapid insulin according to Bullock and Manias (2017)? Explain when NovoRapid should be administered in relation to food intake and why. Support your answer with academic references. 
 
4.Discuss the definition, causes, symptoms and treatment of hypoglycaemia, a common adverse effect of NovoRapid. Support your answer with academic references.
 
5.Discuss the importance of understanding the medication prior to administration. Support your answer with academic references. 
 
6.Discuss the 5 rights of medication administration and why it is important for nurses to follow this procedure. Support your answer with academic references. 
 
7.What is the most appropriate insulin pen needle length for Ben and why? Support your answer with academic references. (5 marks)
 
8.What diabetes specific nursing assessment would you conduct prior to administration of NovoRapid insulin to Ben and why? Support your answer with academic references. 
 
9.Identify the site and angle you would inject the NovoRapid insulin and explain why this was selected for Ben. Discuss infection control considerations. Support your answer with academic references. (5 marks)
 
10.What would you document and where? Why is documentation important? Support your answer with academic or clinical guideline references. 
 
11.Explain the diabetes specific nursing assessment you would provide for Ben post administration of insulin, when you would provide it and why. Support your answer with academic references. 
Part B 
1.Discuss the potential impact of type 1 diabetes on Ben.
Discuss the daily physical challenges of living with type 1 diabetes that Ben may face. Support your answer with academic references. (5 marks)
2.Discuss potential emotional impacts of living with type 1 diabetes that Ben may face. Support your answer with academic references. (5 marks)

Answer:

Part A
1.Firstly, the nurse will need to Ben’s name in full and the date he received the insulin dose. The nurse will also specify the insulin name (NovoRapid insulin) and the dosage. The time and frequency of medication administration should also appear in the medication order. In addition, Ben’s residence and his contact information should be indicated. Lastly, the nurse should write his or her name. All these components, according to Rossetti, Porcellati, Bolli & Fanelli (2008) enhance Ben’s safety.
2.Ben was prescribed NovoRapid because his beta cells cannot synthesize enough insulin and hence his system needs to be supplemented with artificial insulin that can perform similar function as normal insulin. Novorapid is almost similar to the insulin released by the pancreas of a person without diabetes (Goldman-Levine & Lee, 2005). They begin to be active 10-15 minutes after being punctured. Its activity peak is at 30-90 minutes and last between 3 and 4 hours.
3.Novorapid insulin has a shorter duration of action compared to human soluble insulin after subcutaneous injection. According to Bullock & Manias (2017), NovoRapid begin to be active 10-15 minutes after being punctured. Its activity peak is at 30-90 minutes and last between 3 and 4 hours. NovoRapid ® has a faster onset of action and a shorter duration than soluble human insulin. Because of the faster onset of action, NovoRapid ® should usually be administered immediately before a meal (Rossetti, Porcellati, Bolli & Fanelli, 2008).
4.Hypoglycemia in an adult is defined as a blood glucose level below 40 mg / dl, even in the absence of symptoms (Skyler, 2004). It is caused by inadequate intake of glucose or food rich in glucose. The common symptoms include sweating, palpitations, anxiety, changes in the pupillary size and increase in the secretion of saliva by the parotid. Hypoglycemia is treated by intravenous administration of glucose. It is not advisable to administer NovoRapid to hypoglycemic individuals because NovoRapid increase the uptake of blood glucose yet hypoglycemic patients have low level of blood glucose.
5.Since Ben is suffering from type 1 diabetes, it is important to choose medication whose pharmacodynamic properties fit’s Ben’s condition. Ben needs medication that act first. Different medications have different pharmacodynamic properties (Goldman-Levine & Lee, 2005). These properties dictate the time, dosage and frequency. For example, NovoRapid ® produces a faster onset of action compared and hence stands out as the best replacement for insulin deficiency (Florence, 2015). The replacement insulin acts in the same way as naturally produced insulin and helps glucose to enter the blood in the cells (Bullock & Manias, 2013).
6.The first right is the right patient, for our case, Ben is the right patient. The second right is right drug, for this case, NovoRapid. The third right is right of medication. Right of medication describes the right for Ben to be treated. Another right is the right route. For Ben’s case, the right route is subcutaneous route because NovoRapid can be absorbed immediately into blood vessels located in subcutaneous layer. Lastly, the right dose is another key right of medication (Fogarty & McKeon 2006).
7.Needles of 5 and 6 mm in length for an insulin pen or injector are recommended for Ben. This is because Ben can be categorized as an adult patient with reduced body weight or for standard injection into a reduced layer of subcutaneous tissue (Gibney, Arce, Byron & Hirsch 2010). The needles of 5 to 6 mm will ensure that the insulin is delivered to the right point where it can get into blood stream as soon as possible.
8.Some of the assessment to conduct before administering insulin is to determine whether Ben could be having other illness. If it is determined that Ben have another condition, then nurse will have to evaluate the effectiveness of medication and determine the right dosage (Wallace & Matthews 2004).  In addition, nurse will have to assess whether Ben is agitated or stressed, whether he is taking various medications, and his level of physical activity. These assessments will enable nurses choose the best medication and determine the right dosage.  
9.The recommended injection sites for Ben is the anterior wall of the abdomen and the external surface of the thigh. The angle of the injection should be 45 °, and a skin fold should be formed (Gibney, Arce, Byron & Hirsch 2010). Pathogens can enter through the broken skin. Hence it is advisable to use sterilize cotton, sterilized needle and remove the needle in the angle at which it penetrated the injection site in order to avoid infections (Gibney, Arce, Byron & Hirsch 2010).
10.The first thing to document is the name of medication. Based on the diagnosis made, Ben should receive NovoRapid insulin, medication designed to address insulin deficiency (Masse, et al 2018).. NovoRapid is an insulin replacement that is very close to insulin produced by the body. The second thing to document is the amount of dose given (In Qureshi & In Maxwell, 2014). The usual dose is between 0.5 and 1.0 units per kilogram of body weight per day. The third thing to document is route used and site for injection. NovoRapid is given by subcutaneous injection into the abdominal wall, thighs, arms, shoulder or shoulder. Other aspects to document include time administered, initials and signature. Documentations help in ensuring ongoing care is done efficiently (Aitken, Manias & Dunning 2006).
11.One of the post administration assessment is to determine potential side effects. Improper dosing, in most cases, may lead to hyperglycaemia and diabetic ketoacidosis. Ketoacidosis does not occur immediately (George, Byun & Howard-Thompson, 2018). The first symptoms develop slowly over hours or days. Consequently, it is a role of nurse to follow up and assess the effects of every drug administered so as to intervene accordingly in case of contraindication.  It is also important to note that the NovoRapid may cause hypoglycaemia (low blood sugar). The nurse should therefore be ready to assess Ben in order to determine whether he developed hypoglycemia or hyperglycemia (Skyler, 2004).  
Part 2
1.Firstly, it is important to note that the common symptoms of type 1 diabetes include constant thirst, frequent urge to urinate, weakness and drowsiness, blurred vision, sensation of goosebumps, numbness and tingling in the palms and soles, skin problems, poorly healing cuts and scratches, sudden weight loss and severe hunger with proper and full nutrition (Brazeau, Rabasa-Lhoret  & Strychar  et al. (2008). These symptoms may make it inconvenient for Ben to engage in daily activities. If Ben used to go out the whole day, he will have to change his behavior and schedule. In other words, diabetes type 1 will force Ben to live relatively restricted lifestyle.
2.Diabetes mellitus is a physical illness, but it puts our psychological world in check. After the diagnosis can appear compatible pictures with: anxiety, social withdrawal, depression, anger, feelings of guilt and disability and a series of feelings and situations that can worsen the general state of mind of the patient (Wallace & Matthews 2004). Ben has a risk of social isolation or emotional disorders that affect their more social sphere, so it is important to address these aspects. This is why psychologists stress the importance of taking care of internal emotional world by supporting our loved ones, going to group therapy with people suffering from the same condition and / or asking for advice from psychologists who are experts in chronic diseases.
References
Aitken R., Manias E. & Dunning T. (2006). Documentation of medication management by graduate nurses in patient progress notes: a way forward for patient safety. Collegian. 13(4):5–11
Brazeau A. S., Rabasa-Lhoret R. & Strychar I, et al. (2008). Barriers to physical activity among patients with type 1 diabetes. Diabetes Care. 31:2108–9. [PMC free article] [PubMed]
Bullock, S & Manias, E. (2017). Fundamentals of Pharmacology (8e). Pearson.
Bullock, S., & Manias, E. (2013). Fundamentals of Pharmacology. Melbourne: P.Ed Australia.
Florence, A. T. (2015). Physicochemical principles of pharmacy: In manufacture, formulation and clinical use. London: Pharmaceutical Press.
Fogarty G. J. & McKeon C. M. (2006). Patient safety during medication administration: the influence of organizational and individual variables on unsafe work practices and medication errors. Ergonomics. 49:444–56.
George, C. M., Byun, A., & Howard-Thompson, A. (2018). New Injectable Agents for the Treatment of Type 2 Diabetes Part 1 – Injectable Insulins. The American Journal Of Medicine, 131(7), 752-754. doi:10.1016/j.amjmed.2018.01.049
Gibney M. A., Arce C. H., Byron K. J. & Hirsch L. J. (2010). Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: Implications for needle length recommendations. Curr Med Res Opin. 26(6):1519-1530. 3.
Goldman-Levine, J. D. & Lee, K. W (2005). Insulin Detemir–A New Basal Insulin Analog. The Annals of Pharmacotherapy 39: 502-507.
In Qureshi, Z., & In Maxwell, S. R. J. (2014). The Unofficial Guide to Prescribing e-book. Churchill Livingstone
Masse, M., Maton, M., Genay, S., Blanchemain, N., Barthélémy, C., Décaudin, B., & Odou, P. (2018). In vitro assessment of the influence of intravenous extension set materials on insulin aspart drug delivery. Plos One, 13(8), e0201623. doi:10.1371/journal.pone.0201623
Rossetti, P., Porcellati, F., Bolli, G. B., Fanelli, C. G. (2008). Prevention of Hypoglycemia While Achieving Good Glycemic Control in Type 1 Diabetes: The role of insulin analogs. Diabetes Care 31: S113-S120 .
Skyler, J. S. (2004). Effects of Glycemic Control on Diabetes Complications and on the Prevention of Diabetes. Clin. Diabetes 22: 162-166
Wallace T. M. & Matthews D. R. (2004). Recent advances in the monitoring and management of diabetic ketoacidosis. QJM. 97:773–80. [PubMed]

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401209 Health Variations 2

401209 Health Variations 2

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401209 Health Variations 2

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401209 Health Variations 2

0 Download7 Pages / 1,583 Words

Course Code: 401209
University: Western Sydney University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question: 
Details for Health Variations 2- Chronic Illness and disability. the assessment details case study including marking criteria, referencing and language use.
Answer: 

Part A
First of part A 
Components of insulin medication

date and the time when the order is written
name of the drug
dosage of drug
dosage strength
dosage form
route of administration of the drug
The angle of the injection
Frequency and duration of drug administration
Duration of therapy
Indication for use
Signature of physician

Importance of these components

To avoid any confusion related to the drug administration
To prevent the medication errors
To provide the right medication to the right patient  (Steineck, Cederholm, Eliasson, Rawshani, Eeg-Olofsson, Svensson, & Gudbjörnsdóttir, 2015)

Second of part A
As discussed in the case study that the patient admitted to the emergency department due to severe hypoglycaemia which occurs due to imbalanced insulin or insulin resistant. Aspart injected subcutaneously helps to decrease the blood glucose level and takes only 10 to 20 minutes to act after injected. Lantus Solostar is the long acting medicine that starts to work several hours after delivering and it keeps working for around 24 hours. The two medicines help to act immediately and exhibit long lasting effects. Therefore prescribing these medicines to Bens was a good idea.
Diabetes type 1 is the result of autoimmune destruction of beta cells that produce insulin in the pancreas. Insulin Aspart binds to the beta subunits consisting of receptors on the fat and muscle cells and inhibits the secretion of glucose out of the liver. The primary action of insulin Glargine (Lantus) is regulating glucose metabolism. It lowers blood glucose levels by triggering peripheral glucose uptake by muscles and inhibiting the hepatic glucose uptake. (Haidar, Elleri, Kumareswaran, Leelarathna, Allen, Caldwell, & Dunger, 2013) 
Third of part A
The onset of action of Aspart insulin occurs within ten to twenty minutes of injection. The duration of action of is three to five hours. Peak time is 15 minutes. This insulin should be administered after or shortly before or shortly after eating to control the levels of blood glucose after a meal. This is because the levels of insulin disturbed after meal. Taking Novorapid 15 to 20 minutes before eating can provide a significant improvement in after-meal control (Slattery, Amiel, & Choudhary, 2018)
Fourth of part A  
Hypoglycaemia (low blood sugar) is the condition which occurs when insulin levels are high and glucose (sugar) levels are low in the blood. Causes of hypoglycaemia includes Excessive use of insulin or other medications that increase insulin levels, disturbed eating habits after taking medications, Skipping meals, Exercising vigorously without proper nutrition, and Excess consumption of alcohol when on medications, especially if it replaces food.
Symptoms
Symptoms of hypoglycaemia includes Excessive sweating, Shakiness, Dizziness, Moodiness and irritability, Drowsiness, and Confusion (Kalra, Mukherjee, Venkataraman,  Bantwal, Shaikh, Saboo, & Ramachandran, 2013).
Treatment
The patient with hypoglycaemia needs to eat or drink juices or fruits that can rise blood sugar level immediately for example, sugar tablets, fruit juice and carbohydrate snack. In severe case of hypoglycaemia the patient may be prescribed glucagon hormone. (International Hypoglycaemia Study Group, 2015). 
Fifth of part A
Understanding the medication before administration is very important for every nurse or register nurse to avoid any medication errors like wrong medicine, wrong doses, wrong time, route of administration and concentration. Understanding the medication also helps the nurse to have information about the possible side effects of a particular medication and any allergies that the patient has related to a specific type of medicine (Athanasakis, 2015).
Sixth of part A
The five rights of medication administration include

The right patient
Right time
Right Dose
The right route of administration
Right drug

Why it is important to follow these rights

The right drug at right time with right doses helps to achieve the goal already set for the patient. Avoiding these rights may cause health issues and the patient might take legal issues against the health provider (Kim & Bates, 2013).  

Seventh of part A
The insulin pen needle size should be used in case of Ben is 4 mm which is the standard length. It was also found that needles with long size cause more pain to compare to short needles. 4 mm needle is enough to deliver the drug in subcutaneous tissues of the body and fear might be there when administrating the medication (Frid, Kreugel, Grassi, Halimi, Hicks, Hirsch, & Kalra, 2016).
Eighth of part A
Nursing Assessment

The patient should be examined for any allergy to insulin Novorapid or any other contents of this medicine. Because the allergies can impact the beneficial effects of the medicine (American Diabetes Association, 2016).
A nurse should use new needle, already used needle may spread infection (Heise, Hövelmann, Brøndsted, Adrian, Nosek, & Haahr, 2015).

Ninth of part A
The best site for injecting Novorapid is abdomen in case of Ben because this part of the body is easy to reach and the insulin is absorbed more quickly. The skin should be folded 1 or 2 inches to reduce the risk of reaching the injection to muscles. The medicine should be injected at 90-degree angle as it is the easiest angle to inject in the folded skin and ben may feel less pain in this way (Frid, Kreugel, Grassi, Halimi, Hicks, Hirsch, & Kalra, 2016).  
Tenth of part A
The documentation should be done inpatient data sheet or EMAR (electronic medication administration record) and it will include information of:

The timing of injection and understanding of insulin action
Site for injection
Needle length
Correct dose selection
Evidence of damaged injection site with size and location of damage
Issues like physical deficit or psychological issues
And any side effects

Keeping records is necessary to ensure that the right medicine has been administered to the right patient art right time and in a prescribed quantity (Australian Commission on Safety and Quality in Health Care, 2014).
Eleventh of part A

After administration insulin to ben nurse should examine the blood glucose level. This is because checking the levels confirms that the medication worked for him
Ben should be checked for blood ketone level to ensure that the ketone levels are controlled.
He should also be assessed for any side effects (Adhikari, Poudel, Rajbanshi, & Shrestha, 2018)

Part B
First of part B

The patient may feel continue fatigue and this may result in a lack of exercise
He may also have gastroparesis which means delayed emptying the food material from the stomach. This may leads to bloating, nausea, heartburn.  
Kidneys damage may also occur over time due to reduced blood filtration.
Decreased blood flow to the routine can cause eye damage or blindness (Freeborn, Dyches, Roper, & Mandleco, 2013).

Second of part B

The patient may feel tired due to regular testing of blood glucose
Ben may also face a problem in remembering to take the medication on time
Stress may be there
Sometimes the patients develop “why me” thoughts and feeling alone with their diabetes
He likes to play football, being tired due to fatigue may not allow him to do exercise and this may affect him.
Diabetes may also cause behavioral changes (Nicolucci, Kovacs Burns, Holt, Comaschi, Hermanns, Ishii, & Tarkun, 2013).

References:
Adhikari, S., Poudel, R. S., Rajbanshi, L., & Shrestha, S. (2018). Assessment of Insulin Injection Practice of Nurses Working in a Tertiary Healthcare Center of Nepal. Nursing Research and Practice, 2018. 6
American Diabetes Association. (2016). 13. Diabetes care in the hospital. Diabetes Care, 39(1), S99-S104.
Athanasakis, E. (2015). The method of checking medications prior to administration: an evidence review. International Journal of Caring Sciences, 8(3), 801.
Australian Commission on Safety and Quality in Health Care (2014). User guide for nursing and care staff. Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/SAQ123_NursesUserGuide_V6.pdf
Freeborn, D., Dyches, T., Roper, S. O., & Mandleco, B. (2013). Identifying the challenges of living with type 1 diabetes: child and youth perspectives. Journal of clinical nursing, 22(13-14), 1890-1898.
Frid, A. H., Kreugel, G., Grassi, G., Halimi, S., Hicks, D., Hirsch, L. J., & Kalra, S. (2016). New insulin delivery recommendations. In Mayo Clinic Proceedings, 91(9), 1231-1255
Haidar, A., Elleri, D., Kumareswaran, K., Leelarathna, L., Allen, J. M., Caldwell, K., & Dunger, D. B. (2013). Pharmacokinetics of insulin Aspart in pump-treated subjects with type 1 diabetes: reproducibility and effect of age, weight, and duration of diabetes. Diabetes Care, 36(10), e173-e174.
Heise, T., Hövelmann, U., Brøndsted, L., Adrian, C. L., Nosek, L., & Haahr, H. (2015). Faster?acting insulin Aspart: earlier onset of appearance and greater early pharmacokinetic and pharmacodynamics effects than insulin Aspart. Diabetes, Obesity and Metabolism, 17(7), 682-688.
Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing, 22(3-4), 590-598.
Nicolucci, A., Kovacs Burns, K., Holt, R. I., Comaschi, M., Hermanns, N., Ishii, H., & Tarkun, I. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross?national benchmarking of diabetes?related psychosocial outcomes for people with diabetes. Diabetic medicine, 30(7), 767-777.
Slattery, D., Amiel, S. A., & Choudhary, P. (2018). The optimal prandial timing of bolus insulin in diabetes management: a review. Diabetic Medicine, 35(3), 306-316.
Steineck, I., Cederholm, J., Eliasson, B., Rawshani, A., Eeg-Olofsson, K., Svensson, A. M., & Gudbjörnsdóttir, S. (2015). Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18 168 people with type 1 diabetes: observational study. BMJ, 350, h3234.
International Hypoglycaemia Study Group. (2015). Minimizing hypoglycemia in diabetes. Diabetes Care, 38(8), 1583-1591.
Kalra, S., Mukherjee, J. J., Venkataraman, S., Bantwal, G., Shaikh, S., Saboo, B.,  & Ramachandran, A. (2013). Hypoglycemia: The neglected complication. Indian journal of endocrinology and metabolism, 17(5), 819.

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401209 Health Variations 2

401209 Health Variations 2

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401209 Health Variations 2

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401209 Health Variations 2

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Course Code: 401209
University: Western Sydney University

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Question: 
Details for Health Variations 2- Chronic Illness and disability. the assessment details case study including marking criteria, referencing and language use.
Answer: 

Part A
First of part A 
Components of insulin medication

date and the time when the order is written
name of the drug
dosage of drug
dosage strength
dosage form
route of administration of the drug
The angle of the injection
Frequency and duration of drug administration
Duration of therapy
Indication for use
Signature of physician

Importance of these components

To avoid any confusion related to the drug administration
To prevent the medication errors
To provide the right medication to the right patient  (Steineck, Cederholm, Eliasson, Rawshani, Eeg-Olofsson, Svensson, & Gudbjörnsdóttir, 2015)

Second of part A
As discussed in the case study that the patient admitted to the emergency department due to severe hypoglycaemia which occurs due to imbalanced insulin or insulin resistant. Aspart injected subcutaneously helps to decrease the blood glucose level and takes only 10 to 20 minutes to act after injected. Lantus Solostar is the long acting medicine that starts to work several hours after delivering and it keeps working for around 24 hours. The two medicines help to act immediately and exhibit long lasting effects. Therefore prescribing these medicines to Bens was a good idea.
Diabetes type 1 is the result of autoimmune destruction of beta cells that produce insulin in the pancreas. Insulin Aspart binds to the beta subunits consisting of receptors on the fat and muscle cells and inhibits the secretion of glucose out of the liver. The primary action of insulin Glargine (Lantus) is regulating glucose metabolism. It lowers blood glucose levels by triggering peripheral glucose uptake by muscles and inhibiting the hepatic glucose uptake. (Haidar, Elleri, Kumareswaran, Leelarathna, Allen, Caldwell, & Dunger, 2013) 
Third of part A
The onset of action of Aspart insulin occurs within ten to twenty minutes of injection. The duration of action of is three to five hours. Peak time is 15 minutes. This insulin should be administered after or shortly before or shortly after eating to control the levels of blood glucose after a meal. This is because the levels of insulin disturbed after meal. Taking Novorapid 15 to 20 minutes before eating can provide a significant improvement in after-meal control (Slattery, Amiel, & Choudhary, 2018)
Fourth of part A  
Hypoglycaemia (low blood sugar) is the condition which occurs when insulin levels are high and glucose (sugar) levels are low in the blood. Causes of hypoglycaemia includes Excessive use of insulin or other medications that increase insulin levels, disturbed eating habits after taking medications, Skipping meals, Exercising vigorously without proper nutrition, and Excess consumption of alcohol when on medications, especially if it replaces food.
Symptoms
Symptoms of hypoglycaemia includes Excessive sweating, Shakiness, Dizziness, Moodiness and irritability, Drowsiness, and Confusion (Kalra, Mukherjee, Venkataraman,  Bantwal, Shaikh, Saboo, & Ramachandran, 2013).
Treatment
The patient with hypoglycaemia needs to eat or drink juices or fruits that can rise blood sugar level immediately for example, sugar tablets, fruit juice and carbohydrate snack. In severe case of hypoglycaemia the patient may be prescribed glucagon hormone. (International Hypoglycaemia Study Group, 2015). 
Fifth of part A
Understanding the medication before administration is very important for every nurse or register nurse to avoid any medication errors like wrong medicine, wrong doses, wrong time, route of administration and concentration. Understanding the medication also helps the nurse to have information about the possible side effects of a particular medication and any allergies that the patient has related to a specific type of medicine (Athanasakis, 2015).
Sixth of part A
The five rights of medication administration include

The right patient
Right time
Right Dose
The right route of administration
Right drug

Why it is important to follow these rights

The right drug at right time with right doses helps to achieve the goal already set for the patient. Avoiding these rights may cause health issues and the patient might take legal issues against the health provider (Kim & Bates, 2013).  

Seventh of part A
The insulin pen needle size should be used in case of Ben is 4 mm which is the standard length. It was also found that needles with long size cause more pain to compare to short needles. 4 mm needle is enough to deliver the drug in subcutaneous tissues of the body and fear might be there when administrating the medication (Frid, Kreugel, Grassi, Halimi, Hicks, Hirsch, & Kalra, 2016).
Eighth of part A
Nursing Assessment

The patient should be examined for any allergy to insulin Novorapid or any other contents of this medicine. Because the allergies can impact the beneficial effects of the medicine (American Diabetes Association, 2016).
A nurse should use new needle, already used needle may spread infection (Heise, Hövelmann, Brøndsted, Adrian, Nosek, & Haahr, 2015).

Ninth of part A
The best site for injecting Novorapid is abdomen in case of Ben because this part of the body is easy to reach and the insulin is absorbed more quickly. The skin should be folded 1 or 2 inches to reduce the risk of reaching the injection to muscles. The medicine should be injected at 90-degree angle as it is the easiest angle to inject in the folded skin and ben may feel less pain in this way (Frid, Kreugel, Grassi, Halimi, Hicks, Hirsch, & Kalra, 2016).  
Tenth of part A
The documentation should be done inpatient data sheet or EMAR (electronic medication administration record) and it will include information of:

The timing of injection and understanding of insulin action
Site for injection
Needle length
Correct dose selection
Evidence of damaged injection site with size and location of damage
Issues like physical deficit or psychological issues
And any side effects

Keeping records is necessary to ensure that the right medicine has been administered to the right patient art right time and in a prescribed quantity (Australian Commission on Safety and Quality in Health Care, 2014).
Eleventh of part A

After administration insulin to ben nurse should examine the blood glucose level. This is because checking the levels confirms that the medication worked for him
Ben should be checked for blood ketone level to ensure that the ketone levels are controlled.
He should also be assessed for any side effects (Adhikari, Poudel, Rajbanshi, & Shrestha, 2018)

Part B
First of part B

The patient may feel continue fatigue and this may result in a lack of exercise
He may also have gastroparesis which means delayed emptying the food material from the stomach. This may leads to bloating, nausea, heartburn.  
Kidneys damage may also occur over time due to reduced blood filtration.
Decreased blood flow to the routine can cause eye damage or blindness (Freeborn, Dyches, Roper, & Mandleco, 2013).

Second of part B

The patient may feel tired due to regular testing of blood glucose
Ben may also face a problem in remembering to take the medication on time
Stress may be there
Sometimes the patients develop “why me” thoughts and feeling alone with their diabetes
He likes to play football, being tired due to fatigue may not allow him to do exercise and this may affect him.
Diabetes may also cause behavioral changes (Nicolucci, Kovacs Burns, Holt, Comaschi, Hermanns, Ishii, & Tarkun, 2013).

References:
Adhikari, S., Poudel, R. S., Rajbanshi, L., & Shrestha, S. (2018). Assessment of Insulin Injection Practice of Nurses Working in a Tertiary Healthcare Center of Nepal. Nursing Research and Practice, 2018. 6
American Diabetes Association. (2016). 13. Diabetes care in the hospital. Diabetes Care, 39(1), S99-S104.
Athanasakis, E. (2015). The method of checking medications prior to administration: an evidence review. International Journal of Caring Sciences, 8(3), 801.
Australian Commission on Safety and Quality in Health Care (2014). User guide for nursing and care staff. Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/SAQ123_NursesUserGuide_V6.pdf
Freeborn, D., Dyches, T., Roper, S. O., & Mandleco, B. (2013). Identifying the challenges of living with type 1 diabetes: child and youth perspectives. Journal of clinical nursing, 22(13-14), 1890-1898.
Frid, A. H., Kreugel, G., Grassi, G., Halimi, S., Hicks, D., Hirsch, L. J., & Kalra, S. (2016). New insulin delivery recommendations. In Mayo Clinic Proceedings, 91(9), 1231-1255
Haidar, A., Elleri, D., Kumareswaran, K., Leelarathna, L., Allen, J. M., Caldwell, K., & Dunger, D. B. (2013). Pharmacokinetics of insulin Aspart in pump-treated subjects with type 1 diabetes: reproducibility and effect of age, weight, and duration of diabetes. Diabetes Care, 36(10), e173-e174.
Heise, T., Hövelmann, U., Brøndsted, L., Adrian, C. L., Nosek, L., & Haahr, H. (2015). Faster?acting insulin Aspart: earlier onset of appearance and greater early pharmacokinetic and pharmacodynamics effects than insulin Aspart. Diabetes, Obesity and Metabolism, 17(7), 682-688.
Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing, 22(3-4), 590-598.
Nicolucci, A., Kovacs Burns, K., Holt, R. I., Comaschi, M., Hermanns, N., Ishii, H., & Tarkun, I. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross?national benchmarking of diabetes?related psychosocial outcomes for people with diabetes. Diabetic medicine, 30(7), 767-777.
Slattery, D., Amiel, S. A., & Choudhary, P. (2018). The optimal prandial timing of bolus insulin in diabetes management: a review. Diabetic Medicine, 35(3), 306-316.
Steineck, I., Cederholm, J., Eliasson, B., Rawshani, A., Eeg-Olofsson, K., Svensson, A. M., & Gudbjörnsdóttir, S. (2015). Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18 168 people with type 1 diabetes: observational study. BMJ, 350, h3234.
International Hypoglycaemia Study Group. (2015). Minimizing hypoglycemia in diabetes. Diabetes Care, 38(8), 1583-1591.
Kalra, S., Mukherjee, J. J., Venkataraman, S., Bantwal, G., Shaikh, S., Saboo, B.,  & Ramachandran, A. (2013). Hypoglycemia: The neglected complication. Indian journal of endocrinology and metabolism, 17(5), 819.

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My Assignment Help. Health Variations 2 [Internet]. My Assignment Help. 2021 [cited 18 December 2021]. Available from: https://myassignmenthelp.com/free-samples/401209-health-variations-2/components-of-insulin-medication.html.

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Electroconvulsive therapy (ECT) is the deliberate inducing of a modified generalized seizure in an anaesthetized patient under medically-controlled conditions to produce a therapeutic effect (Kavanagh & McLoughlin, 2009). To achieve this, an electric charge is passed through the brain between two electrodes that are placed on the scalp of the anaesthetized patient. Electroconvulsive therapy is used to cause changes in…
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In Australia, the MHN reports that most cases of chronic mental illness are due depression: either socially or economically associated (Reich, 2015). Also, the bipolar condition and schizophrenia disorder have been on the increase up to the early 2000s after which the federal government is liaising with the MHN, and the state governments intervened through regulation of Medicare safety net and Medicare Levy (Dzipora and A…
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1.
The advantages of larger MTU is:
They are appropriate for handling the transfer of the larger amount of the data that is set over the longer distance.
There is no major fragmentation important for fast delivery and few lost datagrams.
The advantages are for small MTU:
With good transferring of the time sensitive data like the audio or the video.
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Introduction
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